Bioethics in 2017

Assisted Suicide: Last year, Colorado voters and the Washington, D.C. City Council legalized physician-assisted suicide. Ohio, by contrast, passed a law making assisted suicide a felony, no matter who does the helping, and attempts to legalize doctor-prescribed death in about half the states failed. Expect advocates across the country—funded in the abundant millions by George Soros—to push legalization again, with the greatest efforts focused in Hawaii, Massachusetts, New York, and New Jersey.

While this issue mostly plays out at the state level, there is potential for the debate to go federal. In 1997, the United States Supreme Court ruled 9-0 that there is no constitutional right to assisted suicide. I believe advocates would like to try again for an assisted suicide Roe v. Wade—such as they just achieved in Canada—but they would need around twenty states to legalize in order to make another go at it. Opponents of assisted suicide could strike a body blow by amending the Controlled Substances Act to prohibit the use of federally regulated drugs in the intentional ending of life. Indeed, during the Bush years, the Department of Justice interpreted the CSA to that effect, but that interpretation was deemed invalid by the United States Supreme Court, for failure to follow proper administrative procedures. It is worth noting, however, that the Court ruled that Congress could pass such a prohibition. Perhaps some intrepid congressperson or senator will take up that important cause.

Futile Care: Futile care is a form of ad hoc health-care rationing. Doctors and hospital bioethics committees are empowered to refuse to provide wanted life-sustaining treatment, based on their perception of the patient’s quality of life and/or cost-of-care considerations—a true “death panel.” The bioethics movement has been quietly pushing futile care for years, with mixed success, mostly via internal hospital administrative policies.

Texas—improbable as it might seem—has the most explicitly pro-futile care law. Repealing the Texas law has proved difficult. But a major legal challenge has now been mounted, seeking to declare the law unconstitutional. Notably, the Texas Attorney General decided not to defend the futile care provisions of Texas law. If the law is ruled unconstitutional, it will be a blow to the futile care movement nationwide. If it is not, look for increased legislative efforts to grant bioethics committees the legal right to make the ultimate decision about whether to provide life-sustaining medical treatment.

Brave New World: The term “Brave New World” encompasses a number of developing, futuristic biotechnologies that have the potential to influence culture, medicine, and our concept of the human family. Did I say “futuristic”? That “future” is already here. Though it has been little noted in the media, scientists have successfully accomplished human cloning, manufacturing four human embryos via the same process that created Dolly the sheep. Researchers are on the verge of creating sperm and eggs from skin cells. In rodent tests, these gametes were successfully fertilized and pups were born. The UK has opened the door to the creation of “three-parent” embryos, now intended to prevent the transmission of mitochondrial disease but with the potential to create novel family forms. The FDA has also begun considering the question. Bioscientists are beginning to clamor for permission to experiment on twenty-eight-day-old embryos, twice the current general fourteen-day restriction on maintaining embryos for experiments. A form of gene editing called CRISPR makes it easy to genetically engineer any organism, including human beings.

Given our increasing biotechnological prowess and the potential consequences of these new developments, properly regulating these areas should be the subject of intense democratic deliberation. Instead, we hear the corn growing. But that could change. The birth of a cloned human being or the attempt to gestate a genetically engineered baby, the development of an artificial womb (currently in animal testing), or some other such sudden breakthrough—any of these could awaken the sleeping giant and spark an intense policy brouhaha.

Medical Conscience: Should doctors and nurses be forced to provide abortions even if they believe that doing so would be a mortal sin? Should a doctor who is opposed to assisted suicide be forced, where that procedure is legal, to discuss it with his patients? Should Catholic hospitals that receive public funding be legally required to sterilize patients who request it? Is it “sex discrimination” for a health-insurance company to refuse coverage for elective abortions? Forcing doctors, nurses, pharmacists, and medical institutions to perform or permit legal medical procedures that violate their religious or moral consciences is fast becoming one of the hottest of hot-button issues in bioethics. Imagine a court ordering a Catholic hospital to perform an abortion or else face millions of dollars in damages. The societal clash such a decision would provoke would quickly reach Terri Schiavo levels.

Animal Research: For nearly four decades, the animal liberation movement has been at war with medical research conducted on animals—even though conducting such experiments before trying new drugs or procedures on people is a crucial human rights protection established in the Nuremberg Code. Hostility to animal research now extends beyond the animal rights movement. The NIH will no longer fund experiments using chimpanzees—based on animal welfare criteria—which is understandable, given chimpanzees’ high intelligence and social needs. But there is also an incipient movement to thwart research on other primates, even though doing so would cause tremendous harm to the biological sciences and medical advancements. For example, a new Ebola vaccine was just developed, and its creation required the use of monkeys. Animal welfare is an important issue, but so is human thriving. The simmering controversy over experiments on primates and other lab animals could heat up wherever there are attempts to impose undue restrictions.

These are just a few of the many controversial bioethical issues we will be hearing more about. Some bioethicists want to do away with the dead donor rule in organ transplant medicine, opening the prospect of live human harvesting. The abortion issue never goes away. And the movement to repeal and replace Obamacare is sure to be fraught with bioethical controversy. To paraphrase a famous quote attributed to Leon Trotsky: You may not be interested in bioethics, but bioethics is interested in you.